Structural analysis of the phimotic prepuce in patients with failed topical treatment compared with untreated phimosis

Abstract

Objectives: To evaluate histological alterations in prepuce of patients with phimosis submitted to topic treatment with betamethasone in association with hyaluronidase. Materials and Methods:We studied sixty patients (mean age 4.5), presenting true phimosis and treated with a topical treatment with betamethasone cream (0.2%) + hyaluronidase. The parents of seven of these patients opted for circumcision (control group). The other fi fty-three patients were submitted to clinical treatment. The samples were stained with Weigert's resorcin-fuchsin (analysis of the elastic fi bers) and Picro-Sirius Red, for analysis of the collagen. The volumetric density of the elastic fi bers was determined by stereological methods. Results: Only eight (15%) of the fi fty-three patients submitted to topical treatment presented failure, being indicated for circumcision (histological analysis). We observed an increase of the collagen type III of the patients submitted to topical treatment. The quantifi cation showed a reduction of the volumetric density of the prepuce's elastic fi bers of the patients submitted to the cream treatment, when compared to the control group (p = 0.056). The volumetric density of the elastic fi bers of the prepuce at the group not submitted to topical treatment showed an average of 14.60% (11.06 to 21.64%); in the group submitted to the cream treatment, the volumetric density of the elastic fi bers of the prepuce showed an average of 10.34% (3.45 to 17.9%). Conclusion:The topical treatment of phimosis with betamethasone 0.2% + hyaluronidase had a success rate of 85%. Patients with failure of the topical treatment with steroid had histological alterations in the prepuce.

Effectiveness of dexamethasone and hyaluronidase + valerate of bethasone associated with prepucial massage in the treatment of child phimosis

“…The postectomy surgery triggers stress and anxiety in patients, and these experiences are threat to their physical integrity [10,11]. Although it is very effective, it poses considerable risks, since general anesthesia is necessary and complications reach 34%, being the most recurrent ones: hemorrhage, urethral meatitis and preputial ring stenosis, and even amputation of the glans [5]. Some authors propose that circumcision, without therapeutic purposes, is an unethical act, since the procedure constitutes mutilation of part of the body without the consent of the child [12].…”

“…Although circumcision is very effective, its preference as the irst line of treatment has been questioned after the results of topical corticosteroid treatment. The surgical procedure, besides costing more than double the topical treatment, poses considerable risks to the patient, since general anesthesia is necessary and complications reach 34%, being the most frequent: hemorrhage, pain, infection, urinary obstruction, bad esthetic results and other rarer ones: urethral meatitis and preputial ring stenosis, and even amputation of the glans [5,6].…”

“…However, it is extremely important to perform the preputial massage, since there is no ef icacy in the treatment without it [4,7]. After the period of drug therapy, the need to continue the massage and maintain good local hygiene is stressed, in order to avoid relapses [5]. Low cost and promising results, with success rates of up to 95%, make the choice by this plausible therapeutic method before the immediate surgical indication [4].…”

Two case reports of unusual phimosis in rhesus monkeys (Macaca Mulatta)

“…In human males, the physiological phimosis affects 96% of newborns and its incidence decreases with age. About 10% of the patients present phimosis at 3 years of age, and only 1% present the disease at 14 years of age …”

“…About 10% of the patients present phimosis at 3 years of age, and only 1% present the disease at 14 years of age. 7 No breed and species predisposition is known yet. Congenital phimosis is recognizable in neonates but may remain undetected for months.…”